Under the general direction of FLRx Clinical Pharmacists and Medical Specialty Medication Nurse Coordinators performs functions as permitted by law including the initial level processing and review of prior authorization requests for both pharmacy reviews and medical specialty drug reviews based on FLRX drug policies and procedures. This position has direct responsibility and accountability for accurate case preparation and interpretation in addition to being the content expert for the applications used to process these requests. This position provides expertise in the intake area of the prior authorization process and in processing FLRX exception requests that follow standard protocols.
• Minimum High school diploma is required. AAS degree in a health related field is preferred.
• Pharmacy Technician certification (CPhT) is strongly preferred for level I employment; it is required for consideration of promotion to the second level of the position.
• Basic understanding and interpretation of medical terminology and diagnosis codes is required.
• Basic understanding of drug classes and therapeutic interchange as described in the FLRx drug policies is required.
• A clear understanding of prescription and medical benefits as it applies to the utilization review process is required.
• Basic math skills, good data entry and information retrieval skills required.
• Strong PC and commonly used software skills.
• Strong communication skills are necessary including written, verbal, and telephone.
• Must possess a high degree of professionalism, solid customer service orientatation, strong work ethic and the ability to maintain a positive attitude when dealing with both internal and external customers.
• Must be conscientious, efficient and accurate in prior-authorization, exception and medical/Rx necessity review processing.
• Is expected to continually strive to develop and/or refine skills necessary to respond to the customer.
• Demonstrated capability to work independently and apply competent problem solving and analytical abilities to any situation.
In support of the Americans with Disabilities Act, this job description lists only those responsibilities and qualifications deemed essential to the position.
Equal Opportunity Employer
Univera Healthcare - 2 years ago